Employee Injury Incident Report


employee injury incident report template
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How to draft a Employee Injury Incident Report? Download this Employee Injury Incident Report template now!

We support you and your company by providing this Employee Injury Incident Report HR template, which will help you to make a perfect one! This will save you or your HR department time, cost and efforts and help you to reach the next level of success in your work and business!

This Employee Injury Incident Report has ways to grab your reader’s attention. It is drafted by HR professionals, intelligently structured and easy-to-navigate through. Pay close attention to the most downloaded HR templates that fit your needs.     

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Description continued on attached sheets: ‰ Step 3: Why did the incident happen Unsafe workplace conditions: (Check all that apply) ‰ Inadequate guard ‰ Unguarded hazard ‰ Safety device is defective ‰ Tool or equipment defective ‰ Workstation layout is hazardous ‰ Unsafe lighting ‰ Unsafe ventilation ‰ Lack of needed personal protective equipment ‰ Lack of appropriate equipment / tools ‰ Unsafe clothing ‰ No training or insufficient training ‰ Other: Unsafe acts by people: (Check all that apply) ‰ Operating without permission ‰ Operating at unsafe speed ‰ Servicing equipment that has power to it ‰ Making a safety device inoperative ‰ Using defective equipment ‰ Using equipment in an unapproved way ‰ Unsafe lifting ‰ Taking an unsafe position or posture ‰ Distraction, teasing, horseplay ‰ Failure to wear personal protective equipment ‰ Failure to use the available equipment / tools ‰ Other: Why did the unsafe conditions exist Why did the unsafe acts occur Is there a reward (such as “the job can be done more quickly”, or “the product is less likely to be damaged”) that may have encouraged the unsafe conditions or acts ‰ Yes ‰ No If yes, describe: Were the unsafe acts or conditions reported prior to the incident ‰ Yes ‰ No Have there been similar incidents or near misses prior to this one ‰ Yes ‰ No 4 Step 4: How can future incidents be prevented What changes do you suggest to prevent this incident/near miss from happening again ‰ Stop this activity ‰ Guard the hazard ‰ Train the employee(s) ‰ Train the supervisor(s) ‰ Redesign task steps ‰ Redesign work station ‰ Write a new policy/rule ‰ Enforce existing policy ‰ Routinely inspect for the hazard ‰ Personal Protective Equipment ‰ Other: What should be (or has been) done to carry out the suggestion(s) checked above Description continued on attached sheets: ‰ Step 5: Who completed and reviewed this form (Please Print) Written by: Tit

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